oms recertiﬁcation handbook - nawccb€¦ · the oms recertification process is governed and...

OMSRecertification

Handbook January 2018

The National Alliance of Wound Care & Ostomy® (NAWCO®) is a non-profit organization that is dedicated to the advancement and promotion of excellence in wound care through the certification of wound care practitioners in the United States. The Certification Committee of the NAWCO® is the governing body of the OMS credential.

The aspiration of the NAWCO® is to unify wound care providers & practitioners from different educational backgrounds along the health care continuum in an effort to streamline the delivery of quality wound care.

The NAWCO® offers the Ostomy Management Certification OMS Examination to measure academic and technical competence of eligible candidates in the area of Ostomy Management. Initial certification as an OMS is awarded for a five (5) year period upon receiving a passing score on the examination. Upon expiration of the credentialing term, every OMS is required to recertify with the NAWCO to maintain their credentials.

NAWCO® does not discriminate against any individual on the basis of race, color, creed, age, sex, national origin, religion, disability, marital status, parental status, ancestry, sexual orientation, military discharge status, source of income or any other reason prohibited by law. Individuals applying for the examination will be judged solely on the published eligibility requirements.

This handbook contains information regarding the Ostomy Management Specialist®, OMS, Recertification process of the National Alliance of Wound Care and Ostomy®.

The information contained in this Candidate Handbook is the property of National Alliance of Wound Care and Ostomy® and is provided to candidates who will be taking the certification examination. Copies of this handbook may be downloaded for single personal use, but no part of this handbook may be copied for preparing new works, distribution or for commercial use. NAWCO® does not provide permission for use of any part of the handbook.

To avoid problems in processing your application, it is important that you follow the guidelines outlined in this handbook and comply with our required deadlines. If you have any questions about the policies, procedures, or processing of your application after reading this handbook, please contact the National Alliance of Wound Care and Ostomy®. Additional copies of the handbook may be obtained from our website: www.nawccb.org.

Checklist

Read the Handbook cover to cover. Complete, sign and submit recertification application online Include payment including recertification fee and application processing fee ($380.00) Include additional forms (If applicable):

Continuing Education Verification Form Request for Special Examination Accommodations Documentation of Disability - Related Needs

Contact information National Alliance of Wound Care and Ostomy®PO Box 235Somonauk, IL 60552or fax to: 1-800-352-8339 or email: [email protected]

1National Alliance of Wound Care and Ostomy® OMS Recertification Handbook © 2018

mailto:[email protected]

Table of ContentsObjectives of Recertification 3 ....................................................................................

Credentials 3 ..........................................................................................................

Scope of Practice 3 ..................................................................................................

Administration 3 ......................................................................................................

Recertification Fee (Non-Refundable) 3 .........................................................................

Recertification Deadlines 3 ........................................................................................

Recertification Requirements 4 ...................................................................................

Recertification Options 4 ...........................................................................................Option 1 - Recertification by Examination 4 ............................................................................

Instructions using Option 1 5 ..............................................................................................Option 2 - Recertification by Training 5 .................................................................................

Instructions using Option 2 5 ..............................................................................................Option 3 - Recertification by Continuing Education 5 ................................................................

Instructions using Option 3 5 ..............................................................................................

Reinstatement of Lapsed Credentials 6 .........................................................................Final Ruling on Lapsed Credentials 6 .....................................................................................

Application Process 7 ...............................................................................................

Audit Process 7 .......................................................................................................

Recertification Agreement Policy/Statement of Understanding 7 .........................................

OMS Recertification At A Glance 11 ..............................................................................

NAWCO® Recertification Application 12 .......................................................................

Request for Special Examination Accommodations 14 ......................................................

Documentation of Disability-Related Needs 15 ...............................................................

Continuing Education Verification Record 16..................................................................


Objectives of RecertificationRecertification is a means of providing ongoing assessment of the continued competence and professional growth of the OMS. The NAWCO mandates recertification every five years to ensure that the OMS is exposed to new clinical advancements and standards of care within the area of ostomy management.

This assures consumers that any practitioner awarded the OMS credential has kept abreast of any new developments. And has maintained active continuing education and practice activities to strengthen their knowledge in the area of ostomy management.

CredentialsThe role of the OMS is based upon expert evidence-based clinical knowledge and skills that are practiced in acute, outpatient, long-term care, and home care settings. The focus of the OMS is on high quality care to achieve optimum patient outcomes and cost control in diabetic wound management and prevention of complications.

In order to assure appropriate and thorough diabetic wound management, a holistic comprehensive approach is utilized. All factors affecting healing, including considerations of systemic, psychosocial, and local factors are reviewed. The OMS provides direct patient care, necessary patient education, and prevention measures through comprehensive assessment, referrals, and continuing evaluation of high risk diabetic patients and all types of diabetic wounds.

Diabetic wound management requires the skills of the interdisciplinary team that includes the DWC®, physician, nurse, dietitian, physical therapist, occupational therapist, social worker, and other health care disciplines or providers depending upon each individual patient assessment.

The OMS scope of practice is performed in accordance with legislative code and scope of practice as determined by each respective professional state licensing board.

Scope of PracticeThe OMS provides direct patient ostomy care in ambulatory, acute, long-term care and home care settings. The OMS plays an important role as a direct care provider, educator and resource for optimum patient outcomes in ostomy management.

The OMS scope of practice is performed in accordance with legislative code and scope of practice as determined by each respective professional state regulatory board.

Ostomy Management includes the identification, assessment, management, prevention, and continuing evaluation of patients with ostomy and stoma complications, as well as skin conditions resulting from appliance failure and surgical procedures.

Ostomy Management is a specialized area that focuses on overall stoma and peristomal skin care, and promotion of an optimal stoma environment, including prevention, therapeutic and rehabilitative interventions.

Ostomy Management requires the skills of the interdisciplinary team which includes the physician, nurse, OMS, dietitian, physical therapist, occupational therapist, social worker, and other health care disciplines or providers depending upon each individual patient assessment. The physician or other advanced practice provider is the leader of the interdisciplinary care team. As such, ostomy management care plans must always be prescribed by the physician or other advanced practice provider.

AdministrationThe OMS recertification process is governed and administered by the National Alliance of Wound Care and Ostomy® and its Certification Committee.

Recertification Fee (Non-Refundable)$30.00 Application Processing fee

$350.00 Recertification fee

Recertification DeadlinesAll OMS credentials expire five years to the date after initial certification. Expiration dates are located on your OMS certificate. You can download a copy on the Member’s Only section of the NAWCO® website.

Applications for recertification will be accepted no earlier than 6 months prior to expiration of OMS credential and no later than postmark of expiration date.


Recertification RequirementsApplicants for recertification of the OMS credential must meet all of the following criteria:

1. Active unrestricted license as a Registered Nurse, Licensed Practical/Vocational Nurse, Nurse Practitioner, Physical Therapist, Physical Therapist Assistant, Occupational Therapist, Occupational Therapy Assistant, Physician, or Physician Assistant.

2. Current OMS credential. (Not lapsed)

3. Payment of required fees.

4. Submission of recertification application for one of the following recertification options:

a. Examination

b. Training: Course that meets the criteria established bhy certification committee. (additional fees apply)

c. Continuing Education (60 contact hours)

Recertification OptionsEach OMS must choose one (1) of the three (3) following recertification options:

Option 1 - Recertification by ExaminationThis option allows you to apply for recertification by retaking the NAWCO® OMS certification examination. The NAWCO® certification exam is available in a computerized format with a total testing time of two (2) hours at various computer testing sites. A passing score is required to qualify for recertification. See official NAWCO® OMS Candidate Handbook at www.nawccb.org for more details.

By choosing the option of recertification by examination, the OMS forfeits the opportunity to choose any other option for recertification. Example: An OMS who fails the exam to recertify cannot change and recertify by submitting continuing education credits or by attending the training program.

You may apply and take the examination for recertification up to six (6) months prior to expiration of your credential. Upon receipt of your recertification application for examination, a confirmation letter will be sent to you with instructions for scheduling your examination. Please see the official NAWCO® OMS Candidate Handbook for exam policies, procedures and study references.

Candidates who take the examination for recertification and are unsuccessful may retake the examination three (3) additional times for a total of four (4) attempts within the last (6) months prior to the credential expiration date. If you are unsuccessful after four (4) attempts, you are required to wait one (1) year before reapplying. If, however, you do not complete four (4) exam attempts, you do not have to wait one(1) year to reapply.

All applications must be submitted and the exam must be passed prior to expiration of OMS certification. Application and $380 fees are required for each examination. Candidates who do not successfully pass the examination before the expiration date of their credentials will be considered “lapsed”. Please refer to “Reinstatement of Lapsed Credentials” section for further information.

Certification Month and Day Expires:

Earliest Application Submission

6 months prior to expiration

January July

February August

March September

April October

May November

June December

July January

August February

September March

October April

November May

December June


https://www.wcei.net/

Instructions using Option 11. Complete NAWCO® Recertification Application.

2. Submit along with $380 fee to:a. Mail: National Alliance of Wound Care

and Ostomy®PO Box 235Somonauk, IL

b. Fax: 1-800-352-8339

c. Email: [email protected]

Application must be submitted and examination passed prior to certification renewal date.

Option 2 - Recertification by Training This recertification option allows candidates to attend an NAWCO® reviewed “Ostomy Management Course” on-site course only, no exam required - additional fees apply)

Courses that meet the criteria that has been established by the certitication committee are listed on the NAWCO website at nawccb.org.

Instructions using Option 21. Complete NAWCO® Recertification Application.

2. Submit along with $380 fee to:a. Mail: National Alliance of Wound Care

and Ostomy®PO Box 235Somonauk, IL 60552

b. Fax: 1-800-352-8339

c. Email: [email protected].

3. Register with a course providerfor the on-site training course. The course should be completed no earlier than 6 months prior to expiration of your OMS credential, and must be completed prior to the certification renewal date.

a. Please verify with NAWCO that the course you have chosen to take meets the criteria that has been established by the certification committee.

b. If a course is selected that does meet the criteria, the hours earned will be applied towards recertification by continuing education, provided there is a Certification of Completion with contact hours awarded as described in Option 3.

b. Additional fees apply. Course fee will be paid to the education provider that is chosen.

c. Upon successful completion, the course completion certificate must be forwarded to NAWCO as proof of attendance.

d. Once the course has been completed, and NAWCO® has been notified of the successful completion of the ostomy management course, the NAWCO® will send you an email with information on how to download your new materials on the Certificant's Login section of the NAWCO® website.

Option 3 - Recertification by Continuing EducationTo recertify by continuing education, sixty (60) contact hours (same as clock hours) of continuing education related to ostomy and/or wound management must be earned within the five (5) year certification period. All contact hours must be obtained during the five (5) year period to ensure adequate and current continuing education. A contact hour is defined as a unit of measurement that describes one (1) hour of an approved organized learning experience.

To receive credit for the contact hours, the educational program must be approved/accredited by either the state board governing your primary license (or any state board governing the professional license type under which you practice), the American Nurses Credentialing Center (ANCC®), American Physical Therapy Association, (APTA®) , Accreditation Council for Continuing Medical Education (ACCME®) , or Council on Podiatric Medical Education (CPME®) .

NAWCO® does not require the submission of copies of continuing education certificates with the re-certification application, however, each OMS is responsible for maintaining his/her own records of CE programs completed. In general, records should be kept for two renewal periods (10 years). In the event you are selected by the NAWCO® for an audit, you will be required to submit copies of certificates, and CE program documentation at that time.

Instructions using Option 31. Complete online NAWCO® Recertification

Application.



2. Complete Continuing Education Verification Form located online at nawccb.org.

3. Submit both forms along with $380 fee to:a. Mail: National Alliance of Wound Care

and Ostomy®PO Box 235 Somonauk, IL

b. Fax: 1-800-352-8339

c. Email: [email protected]

Whichever pathway is chosen, application and recertification fees must be submitted and the recertification process completed prior to certification renewal date.

Reinstatement of Lapsed CredentialsReinstatement of a lapsed credential is not the same process as recertification. Requirements for reinstatement of lapsed OMS credentials include all of the following criteria:

1. Active unrestricted license as a Registered Nurse, Licensed Practical/Vocational Nurse, Nurse Practitioner, Physical Therapist, Physical Therapist Assistant, Occupational Therapist, Occupational Therapy Assistant, Physician Assistant, or Physician.

2. Previous OMS certification.

3. Active involvement in the care of wound care patients, or in management, education or research directly related to wound care for at least two (2) years full-time or four (4) years part-time within the past five (5) years.

4. Completion of application.

5. Payment of required fee. $380.00 for reinstatement of certification and $300.00 for late fee. (Total $680.00)

6. Choice of one of the following pathways:

a. Successful graduate of approved“Ostomy Management Course”.

b. Receive passing score on examination within two (2) years or four (4) attempts (whichever comes first) of credentials lapse*.

b. Complete the continuing educationverification form. (A minimum of 60contact hours per requirements mustbe documented). This form can befound at nawccb.org.

i. Copies of original “certificatesof completion” forms from eachcontinuing education programentered on your continuingeducation verification form maybe requested.

ii. Certificate of completion formsmust include your name, date,program title, provider,approved accreditingorganization, and the number ofcontact hours awarded.

7. A OMS that successfully meets therequirements of the chosen and acceptedpathway, within 2 years of the credentiallapsing, will maintain their originalcertification number.

8. A OMS that does not successfully meet therequirements within 2 years of the credentiallapsing, will receive a new certificationnumber when all eligibility criteria have beenmet.

Final Ruling on Lapsed Credentials1. Reinstatement attempt WITHIN 2 YEARS

through Examination Pathway:

a. Unsuccessful: If examination pathway ischosen, after two years or four attempts,you will no longer be able to reinstate yourlapsed credential.

b. You will be required to wait one year andmeet all of the eligibility requirementsagain for certification under one of theexisting initial certification options.

2. Reinstatement attempt AFTER 2 YEARS:

a. A credential that has lapsed beyond 2 yearswill not be reinstated.

b. If you fail to apply to reinstate yourcredential within two years of thecredential expiration, you can applyimmediately and must meet all eligibilityrequirements again for certification underone of the existing certification options.


http://nawccb.org


http://nawccb.org

c. A new certification number will be issuedto successful candidates.

3. If you can demonstrate that you were falselyimprisoned, held hostage or otherwise heldagainst your will, on active duty out of the USin the military, or in a coma, and as a result,unable to complete your recertification priorto credential lapse, then you may reinstateyour credential via any of the recertificationoptions available.

Application ProcessApplications will NOT be processed until all fees have been paid. The processing of your NAWCO® recertification application will vary depending on pathway chosen, but will not exceed two (2) weeks. If your application is approved, you will receive an email with certification maintenance information and a new certificate. Recertification of your OMS credential will be granted for five (5) years. If your application is denied, you will be notified in writing. Application fees are deposited upon receipt. If you withdraw your application after submission, there are no refunds. If your application is denied, you will be issued a refund less a $30 application-processing fee.

It is not necessary to send any supporting CE certificates with your application. Each OMS is responsible for maintaining his/her own records of CE programs completed. In general, records should be kept for two (2) renewal periods (10 years). In the event you are selected by the NAWCO® for an audit, you will be required to submit copies of certificates, etc. at that time. If questions arise during the review of your application, you will be contacted via telephone or certified mail. You will have 15 days from the day you receive the letter to respond.

Deadlines and time frames are strictly enforced and the postmark is very important if you are mailing your application. Whether your application meets the deadline is determined by the postmark. This means that if you mail your application close to the application deadline, you might not learn whether your certification has been renewed until after the expiration date. Deadlines and time frames will apply whether the application is mailed, emailed, or faxed.

If at any time you have questions regarding the recertification process, please call NAWCO® at

1-877-922-6292.

Audit ProcessThe National Alliance of Wound Care and Ostomy® conducts random audits to determine compliance with the recertification requirements. Any OMS selected for audit will be notified by email within two (2) weeks of application receipt. If audited, the documentation required for audit must be submitted to the National Alliance of Wound Care and Ostomy® within 30 days of notice. A OMS may not renew his/her credential until audit documentation is received and approved by the National Alliance of Wound Care and Ostomy® Non-compliance will result in recertification by examination only.

Recertification Agreement Policy/Statement of UnderstandingThe National Alliance of Wound Care and Ostomy® (NAWCO®) is dedicated to the advancement and promotion of excellence in the delivery of skin and wound care management to the consumer.

1. NAWCO® has established a formallydocumented program under which any currentOMS can recertify to demonstrate competencerelating to their proficiency in ostomymanagement. This program includes the OMSprofessional Ostomy Management Specialistcertification credentials. Successfulparticipants in this program may continue touse the OMS certification credential.

2. Definitions:

a. “OMS means any professional currentlycertified by the National Alliance of WoundCare and Ostomy® in consideration forbeing allowed to recertify by the NAWCO®agreed to the terms of this NAWCO®Recertification Program CandidateAgreement (“Agreement”).

b. “Marks” means the service mark and logopertaining to the certification credential.

3. Recertification: Applicant’s recertificationcredential is based on Applicant’s successfulcompletion of one of the four (4) requiredrecertification options and Applicant’scompliance with this Agreement and therequirements described in the correspondingNAWCO® trademark guidelines, the terms ofwhich are incorporated herein by reference,and which may be changed from time to time


by NAWCO® in its sole discretion. Applicant acknowledges that NAWCO® has the right to change at any time the requirements for obtaining or maintaining any certification and/or to discontinue any certification in NAWCO®s sole discretion. Once recertification is granted, applicant may maintain Applicant’s certification by completing, within the time frame specified by NAWCO® all continuing certification requirements, if any, that correspond with Applicant’s OMS credential. NAWCO® is responsible for keeping Applicant informed of NAWCO®s continuing certification requirements and for maintaining Applicant’s certification. If Applicant does not complete the continuing recertification requirements within the time frame specified by NAWCO® Applicant’s certification for that credential will be revoked without further notice, and all rights pertaining to that certification (including the right to use the applicable Marks) will terminate. Applicant retains Applicant’s certification status if Applicant leaves Applicant’s current employment and/or begins working with a new organization. However, Applicant may not transfer Applicant’s certification status to another person. Applicant agrees to make claims regarding certification only with respect to the scope for which the certification has been granted. Applicant agrees to discontinue use of the OMS credential and promotion of the certification immediately upon expiration, suspension or withdrawal of certification. Applicant further swears to notify the NAWCO® in writing within 10 business days if they learn they are no longer eligible to hold the OMS credential, such as in the event of suspension, placement of restrictions upon or revocation of the primary professional license. In the event of revocation of the credential, the applicant agrees to destroy the Certificate of Certification.

4. Notwithstanding anything in this agreement tothe contrary, NAWCO® has the right not togrant, continue, or renew applicant’scertification if NAWCO® reasonably determinesthat applicant’s certification or use of thecorresponding marks will adversely affect theNAWCO® This agreement applies to OMScertification obtained by applicant.

5. Grant and Consideration: Subject to the termsand conditions of this Agreement, NAWCO®grants to Applicant a non-exclusive, personal

and non-transferable license to use the Marks solely in connection with providing services corresponding to the certification credential Applicant has achieved. Applicant may use the Marks on such promotional, display, and advertising materials as may, in Applicant’s reasonable judgment, promote the services corresponding to Applicant’s certification credential and which are permitted by the terms of the NAWCO®s trademark guidelines corresponding to the certification credential. Applicant may not use the Marks for any purposes that are not directly related to the provision of the services corresponding to Applicant’s particular certification. Applicant may not use the Marks of OMS unless Applicant has completed the recertification requirements for the OMS certification credential and has been notified by NAWCO® in writing that Applicant has achieved certification status of OMS NAWCO® reserves the right to revise the terms of this Agreement from time to time. In the event of a revision, Applicant’s signing or otherwise consenting to a new agreement may be a condition of continued certification.

6. Terms and Termination: This Agreement willcommence immediately upon Applicant’sacceptance of the terms and conditions of thisAgreement prior to approval of recertificationapplication. Termination by Either Party:Either party may terminate this Agreementwithout cause by giving thirty (30) days ormore prior written notice to the other party.Termination by NAWCO®: Without prejudice toany other rights it may have under thisAgreement or in law, equity, or otherwise,NAWCO® may terminate this Agreement uponthe occurrence of any one or more of thefollowing events (“Default”):

a. If Applicant fails to perform any ofApplicant’s obligations under thisAgreement;

b. If any government agency or court findsthat any services as provided by Applicantare defective or improper in any way,manner or form; or

c. If actual or potential adverse publicity orother information, emanating from a thirdparty or parties, about Applicant, theservices provided by Applicant, or the useof the Marks by Applicant causes NAWCO®in its sole judgment, to believe that


NAWCO®’s reputation will be adversely affected. In the event of a Default, NAWCO® will give Applicant written notice of termination of this Agreement.

d. Applicant fails to meet recertificationcriteria prior to expiration date of theircredentials.

In the event of a Default under (ii) or (iii)or above, NAWCO® may immediatelyterminate this Agreement with no periodfor correction and without further notice.In the event of a Default under (a) or (d)above, or at NAWCO®’s option under (b) or(c) above, Applicant will be given thirty(30) days from receipt of notice in which tocorrect any Default. If Applicant fails tocorrect the Default within the noticeperiod, this Agreement will automaticallyterminate on the last day of the noticeperiod without further notice.

Effect of Termination: Upon termination of this Agreement for any reason, Applicant will immediately cease all display, advertising, and other use of the Marks and cease all representations of current certification. Upon termination, all rights granted under this Agreement will immediately and automatically revert to NAWCO®.

7. Conduct of Business. Applicant shall:

a. Exercise its independent business judgmentin rendering services to Applicant’scustomers;

b. Avoid deceptive, misleading, or unethicalpractices which are or might bedetrimental to NAWCO® or its products;and

c. Refrain from making any representations,warranties, or guarantees to customers onbehalf of NAWCO®.

d. Without limiting the foregoing, Applicantagrees to not misrepresent Applicant’scertification status or Applicant’s level ofskill and knowledge related thereto.

8. Indemnification By Applicant: Applicant agreesto indemnify and hold NAWCO® harmlessagainst any loss, liability, damage, cost orexpense (including reasonable legal fees)arising out of any claims or suits made againstNAWCO®

a. by reason of Applicant’s performance ornon-performance under this Agreement;

b. arising out of Applicant’s use of the Marksin any manner whatsoever except in theform expressly licensed under thisAgreement; and/or

c. for any personal injury, product liability, orother claim arising from the promotionand/or provision of any products orservices by Applicant. In the eventNAWCO® seeks indemnification under thisSection, NAWCO® will notify Applicant inwriting of any claim or proceeding broughtagainst it for which it seeksindemnification under this Agreement. Inno event may Applicant enter into anythird party agreements which would in anymanner whatsoever affect the rights of, orbind, NAWCO® in any manner, without theprior written consent of NAWCO®. ThisSection shall survive termination orexpiration of this Agreement and allNAWCO® recertification programs for anyreason.

9. Disclaimer of Warranties; Limitation ofLiabilities: NAWCO® makes, and Applicantreceives, no warranties or conditions of anykind, express, implied or statutory, related toor arising in any way out of any recertification,any NAWCO® certification program, or thisAgreement. NAWCO® specifically disclaims anyimplied warranty of merchantability, fitnessfor a particular purpose and non-infringementof any third party rights. In no event shallNAWCO® be liable for indirect, consequential,or incidental damages (including damages forloss of profits, revenue, data, or use) arisingout of this Agreement, any NAWCO®recertification program, or incurred by anyparty, whether in an action in contract or tort,even if NAWCO® has been advised of thepossibility of such damages. NAWCO®s liabilityfor damages relating to any recertification,any NAWCO® certification program, or thisAgreement shall in no event exceed theamount of application fees actually paid toNAWCO® by Applicant. Some jurisdictions donot allow limitations of the liability so certainof these limitations may not apply; however,they apply to the greatest extent permitted bylaw. Applicant acknowledges and agrees thatNAWCO® has made no representation,warranty, or guarantee as to the benefits, if


any, to be received by Applicant from third parties as a result of receiving certification. This Section shall survive termination or expiration of this Agreement and all NAWCO® recertification programs for any reason.

10. General Provisions: Wisconsin law, excludingchoice of law provisions, and the laws of theUnited States of America govern thisAgreement. Failure to require compliance witha part of this Agreement is not a waiver of thatpart. If a court of competent jurisdiction findsany part of this Agreement unenforceable,that part is excluded, but the rest of thisAgreement remains in full force and effect.Any attempt by Applicant to transfer or assignthis Agreement or any rights hereunder is void.Applicant acknowledges and agrees thatApplicant and NAWCO® are independentcontractors and that Applicant will notrepresent Applicant as an agent or legalrepresentative of NAWCO®. This Agreementand all documents incorporated herein byreference are the parties’ complete andexclusive statement relating to their subjectmatter. This Agreement will not besupplemented or modified by any course ofdealing or usage of trade. Any modifications tothis Agreement must be in writing and signed

by both parties. Applicant agrees to comply, at Applicant’s own expense, with all statutes, regulations, rules, ordinances, and orders of any governmental body, department, or agency which apply to or result from Applicant’s rights and obligations under this Agreement.


OMS Recertification At A Glance


NAWCO® Recertification Application


ANY MISSING OR INCOMPLETE INFORMATION MAY CAUSE DELAY IN PROCESSING (1/2018)

1. PRINT NAME: (As listed on your Professional License) ALL ITEMS MUST BE COMPLETED TO BE ELIGIBLE FOR RECERTIFICATIONLAST: FIRST: MIDDLE:

2. MAILING ADDRESS: (Street, City, State & Zip Code)

3. DAYTIME TELEPHONE # E-MAIL: ADA: YES NO

4. SELECT CREDENTIAL FOR RECERTIFICATION: □ WCC □ DWC □ LLE □ OMS □ NWCC 5.CERTIFICATION #:

6. PROFESSIONAL TITLE (LPN, RN, PT, etc) License Type: _______________ License #(s):_________________________

State:_________ ORIGINAL Issue Date:__________________ Expiration Date: _______________

7. RECERTIFICATION PATHWAY: (Indicate your choice and complete additional requiredforms if applicable)□ Option 1: Examination - No Additional Forms□ Option 2: Training - Approved Course□ Option 3: Continuing Education(CE Verification Form)□ Option 4: Mentoring Student: __________________ Option only available for WCC

8. COURSE TYPE: (Required forOption 2: When Choosing Onsite enterlocation and dates)□ Online□ Onsite Date: _______________Location: _____________________

9. APPLICATION-CERTIFICATION FEES : Non-Refundable Processing Fee & Recertification Fee . . . . . . $380.00

10. Agreement Authorization and Certification Information ReleaseBy submitting this Recertification Application, I acknowledge that all supporting documentation provided is true and accurate. If the activities listed on the OMS Activity Report or the supporting verification documents are falsified in any fashion, I understand that this will result in the revocation of my OMS credential.

I affirm that I am currently licensed to practice as a______________________ in the state of___________________.

I further affirm that no licensing authority has current disciplinary action pending against my license to practice in the aforementioned or any other state, and that my license to practice is not currently suspended, restricted or revoked by any state or jurisdiction.

I authorize the National Alliance of Wound Care and Ostomy® Certification Board to make whatever inquires and investigations that it deems necessary to verify my credentials and professional standing. I further allow the National Alliance of Wound Care and Ostomy® Certification Board to use information from my application for the purpose of statistical analysis, provided my personal identification with that information has been deleted.

I have read and understand all the information provided in the NAWCO® recertification handbook. I further agree to abide by the policies and procedures as set forth in the NAWCO® recertification handbook and all conditions included in the NAWCO® candidate recertification agreement.

For listing in the National Alliance of Wound Care and Ostomy® Directory, I hereby authorize the National Alliance of Wound Care and Ostomy® its licensees, successors, and assigns (collectively “NAWCO®”) the right to publish and release my name, past and present certification status under the NAWCO® OMS Certification Directory, and state/province (collectively “Certification Information”) in print and electronic versions of a worldwide directory of NAWCO® OMS Certified Practitioners.

If the NAWCO®, is required by law to release your confidential information, you will be notified by email at the address we have on file, unless prohibited by law. I release the NAWCO®, its subsidiaries and affiliates and their employees, successors, and assigns from any claims of damages for libel, slander, invasion of rights of privacy or publicity, and any other claim based on the publication or release of any Certification Information as specified in this Certification Information Release.

I agree to make claims regarding certification only with respect to the scope for which the certification has been granted. I agree to discontinue use of the OMS credential and promotion of the certification immediately upon expiration, suspension or withdrawal of certification. I further swear to notify the NAWCO® in writing within 10 business days if I learn I am no longer eligible to hold the OMS credential, such as in the event of suspension, placement of restrictions upon or revocation of the primary professional license. I understand that failure to notify the NAWCO® of any of the above listed disciplinary actions will result in revocation of certification and/or denial of recertification. In the event of revocation of the credential, I agree to destroy the Certificate of Certification.

By signing this agreement, I hereby swear and attest to all the contents of the Candidate Recertification Agreement Policy / Statement of Understanding contained within this Candidate Recertification Handbook.

Signature: __________________________________________________________ Date: __________________________


NAWCO® Recertification Application page 2 Applicant Name:

11. PAYMENT: CREDIT CARD AUTHORIZATION FORM: Complete this section ONLY if paying by Credit Card

I, _____________________________________________, hereby authorize the National Alliance of Wound Care and (Name exactly as it appears on card)

Ostomy to charge my credit card account for the amount of $_______________ for ________________________.

❑ Visa ❑ MasterCard ❑ American Express (NO DISCOVER)

Credit Card Number ______________________________ Expiration Date _____/____ Security Code* ___________ *3-digit code found on the end of the signature strip

Credit Card Billing Address: (Address where cardholder receives bill)

Street _________________________________________________________________________________________

City______________________________________________ State__________________ Zip_________________

Telephone: _____________________Cardholder Signature: _______________________________Date: ___________

Request for Special Examination Accommodations Please complete/return this form and the “Documentation of Disability-Related Needs” on the next page at least six (6) weeks prior to test date, so your accommodation for testing can be processed efficiently. The information you provide and any documentation regarding your disability and your need for accommodation in testing will be considered strictly confidential and will not be shared with any outside source without your express written consent. If you have existing documentation of the same or similar accommodation provided for you in another test situation, you may submit such documentation instead of having the reverse side of the form completed by an appropriate professional.

Applicant Information:

_____________________________________________________________________________________________ Last Name First Name Middle Name

_____________________________________________________________________________________________ Address

_____________________________________________________________________________________________ City State Zip Code

_____________________________________________________________________________________________ Daytime Telephone Fax Email

Special Accommodations

I request special accommodations for the ______ / ______ administration of the NAWCO® Credential examination. Month Year

Please provide (check all that applies):

______ Accessible testing site ______ Special seating ______ Large print test (available for paper & pencil proctored examination only) ______ Circle answers in test booklet (available for paper & pencil proctored examination only) ______ Extended testing time (available for computer examination at a PSI testing center - max 2 hours) ______ Separate testing area (table only at PSI testing center) ______ Other special accommodations (please specify) _____________________________________________________________________________________________

_____________________________________________________________________________________________

Comments:___________________________________________________________________________________

_____________________________________________________________________________________________

Signed: ____________________________________________________ Date: _____________________

Return this form with your examination application to:

National Alliance of Wound Care and Ostomy®PO Box 235Somonauk, IL 60552 Or fax to: 1-800-352-8339 Or email: [email protected]



Documentation of Disability-Related Needs If you have a learning disability, a psychological disability, or other disability that requires an accommodation in testing, please have this section completed by an appropriate professional (education professional, doctor, psychologist, psychiatrist) to certify that your disabling condition requires the requested test accommodation. If you have existing documentation of the same or similar accommodation provided for you in another test situation, you may submit such documentation instead of completing the “Professional Documentation” portion of this form.

Professional Documentation

I have known _______________________________________ since _____ / _____ / _____ (Applicant)

in my capacity as _____________________________________________________________. (Professional Title)

The applicant discussed with me the nature of the test to be administered. It is my opinion that because of this applicant’s disability described below, he/she should be accommodated by providing the special arrangements identified on the Special Examination Accommodation Form.

Comments:

_____________________________________________________________________________________________ _____________________________________________________________________________________________

_____________________________________________________________________________________________ Signed:

___________________________________________________________Title:_____________________________

Printed Name: _____________________________________________________

Address:

_____________________________________________________________________________________________ _____________________________________________________________________________________________

Telephone Number: __________________________________ Email: ___________________________________

License # (If applicable):_______________________________ Date: ___________________________________

Return this form with your examination application and request for special examination accommodations to:

National Alliance of Wound Care and Ostomy®PO Box 235Somonauk, IL 60552Or fax to: 1-800-352-8339 Or email: [email protected] or [email protected]




Continuing Education Verification RecordInstructions: Use this form to document continuing education credits if applying for the Recertification, Lapsed Credential Reinstatement by Continuing Education, or Experiential certification pathway. This option requires documentation of completion of a minimum of sixty (60) contact hours of education related to skin and wound care, and nutritional management during the previous five year period. If course titles do not clearly reflect the course‘s relevance to skin and wound care and nutritional management, include a brief description of how the course impacts your practice. You may make copies of this page as needed to document required continuing education. If you have chosen the Experiential pathway, submit with this application, copies of *certificates of completion to support each continuing education program entered on this form.

* Refer to handbook for acceptable continuing education.

Name________________________________________________________________________________________ First Last MI

Record of Wound and Skin Care/Continuing Education

Title/Subject Matter/Content Date Sponsor/Provider/Institution

Location Contact Hours

Total contact hours


!

RETURN COMPLETED APPLICATION WITH FEES TO:

National Alliance of Wound Care and Ostomy® PO Box 235

Somonauk, IL 60552Or fax to: 1-800-352-8339

Or email to: [email protected]


oms recertiﬁcation handbook - nawccb€¦ · the oms recertification process is governed and...

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